The impact of diabetes on multiple avoidable admissions: a cross-sectional study

Abstract Background Multiple admissions for ambulatory care sensitive conditions (ACSC) are responsible for an important proportion of health care expenditures. Diabetes is one of the conditions consensually classified as an ACSC being considered a major public health concern. The aim of this study was to analyse the impact of diabetes on the occurrence of multiple admissions for ACSC. Methods We analysed inpatient data of all public Portuguese NHS hospitals from 2013 to 2015 on multiple admissions for ACSC among adults aged 18 or older. Multiple ACSC users were identified if they had two or more admissions for any ACSC during the period of analysis. Two logistic regression models were computed. A baseline model where a logistic regression was performed to assess the association between multiple admissions and the presence of diabetes, adjusting for age and sex. A full model to test if diabetes had no constant association with multiple admissions by any ACSC across age groups. Results Among 301,334 ACSC admissions, 144,209 (47.9%) were classified as multiple admissions and from those, 59,436 had diabetes diagnosis, which corresponded to 23,692 patients. Patients with diabetes were 1.49 times (p < 0,001) more likely to be admitted multiple times for any ACSC than patients without diabetes. Younger adults with diabetes (18–39 years old) were more likely to become multiple users. Conclusion Diabetes increases the risk of multiple admissions for ACSC, especially in younger adults. Diabetes presence is associated with a higher resource utilization, which highlights the need for the implementation of adequate management of chronic diseases policies.

Download Full-text

Neighborhood Environments and Utilitarian Walking Among Older vs. Younger Rural Adults

Frontiers in Public Health ◽

10.3389/fpubh.2021.634751 ◽

2021 ◽

Vol 9 ◽

Author(s):

Chanam Lee ◽

Chunkeun Lee ◽

Orion T. Stewart ◽

Heather A. Carlos ◽

Anna Adachi-Mejia ◽

...

Keyword(s):

Older Adults ◽

Rural Communities ◽

Public Transportation ◽

Age Groups ◽

Cross Sectional Study ◽

Neighborhood Environment ◽

Cross Sectional ◽

Younger Adults ◽

Logistic Regression Models ◽

Telephone Interviews

Introduction: Walking has the potential to promote health across the life span, but age-specific features of the neighborhood environment (NE), especially in rural communities, linked with walking have not been adequately characterized. This study examines the relationships between NE and utilitarian walking among older vs. younger adults living in US rural towns.Methods: Data for this cross-sectional study came from telephone interviews in 2011–2012 with 2,140 randomly sampled younger (18–64 years, n = 1,398) and older (65+ years, n = 742) adults, collecting personal and NE perception variables. NE around each participant's home was also measured objectively using geographic information system techniques. Separate mixed-effects logistic regression models were estimated for the two age groups, predicting the odds of utilitarian walking at least once a week.Results: Perceived presence of crosswalks and pedestrian signals was significantly related to utilitarian walking in both age groups. Among older adults, unattended dogs, lighting at night, and religious institutions were positively while steep slope was negatively associated with their walking. For younger adults, traffic speed (negative, –), public transportation (positive, +), malls (–), cultural/recreational destinations (+), schools (+), and resource production land uses such as farms and mines (–) were significant correlates of utilitarian walking.Conclusion: Different characteristics of NE are associated with utilitarian walking among younger vs. older adults in US rural towns. Optimal modifications of NE to promote walking may need to reflect these age differences.

Download Full-text

The Impact of the COVID-19 Pandemic and Lockdown on Prevalence of and Risk Factors for Neck Pain Among College Students: a Cross-sectional Study

10.21203/rs.3.rs-701878/v1 ◽

2021 ◽

Author(s):

Amira Daher ◽

Ofra Halperin

Keyword(s):

Risk Factors ◽

College Students ◽

Logistic Regression ◽

Regression Models ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Logistic Regression Models ◽

Related Stress ◽

The Impact

Abstract Background: Neck pain (NP), one of the most reported musculoskeletal disorders, is a major cause of illness and absence from university lessons among students. The COVID-19 pandemic affected higher education institutions worldwide. Academic studies shifted to online-learning, changing students’ habits and lifestyle. Data demonstrated that the pandemic and consequent lockdowns can affect people’s physical and mental well-being. Thus, the aim of this study is to evaluate the impact of COVID-19 lockdowns on the prevalence of and risk factors of NP among college students compared to the pre-epidemic period. Methods: A cross-sectional study was conducted in the form of an online questionnaire survey that included sociodemographic data, Visual Analogue Scale (VAS), Neck Disability Index (NDI), and Perceived Stress Scale (PSS). NP was reported at four time points—lifetime, last year, last six months, and current—on a scale ranging from never/seldom to almost every day. Logistic regression models were calculated for all study variables and compared to the (NDI) cut-off score of 15. Results: A total of 295 college students were recruited. Among them, 35.6% reported at least moderate neck-related disability (NDI≥15) and significantly more NP than before the lockdown. NP increased gradually and significantly (on a scale 1-4), from a lifetime mean of 1.80 to a mean of 2.57 last year to 2.73 during the past six months to the current mean of 3.07 (p< .001). Participants’ scores on the PSS were moderate, with 59.3% reporting a high level of study-related stress. Logistic regression models revealed that sitting more than three hours a day, high study-related stress and higher PSS and VAS scores were associated with higher risk of at least a moderate level of neck-related disability (R2=.513, p< .001). Conclusions: The transition from on-campus studies to online learning had negative effects on students. It significantly increased study-related stress and the development of NP. Identifying risk factors at an early stage may prevent NP from becoming chronic and affecting students’ future careers, thereby improving students’ quality of life.

Download Full-text

Do Hospitals with a Higher Level of Maternal Care Designation Have Better Maternal Outcomes?

American Journal of Perinatology ◽

10.1055/s-0038-1672140 ◽

2018 ◽

Vol 36 (06) ◽

pp. 653-658 ◽

Cited By ~ 2

Author(s):

Sindhu Srinivas ◽

Katy Kozhimannil ◽

Peiyin Hung ◽

Laura Attanasio ◽

Judy Jou ◽

...

Keyword(s):

High Risk ◽

Maternal Care ◽

Maternal Morbidity ◽

Cross Sectional Study ◽

Severe Maternal Morbidity ◽

Maternal Outcomes ◽

Cross Sectional ◽

Discharge Data ◽

Logistic Regression Models ◽

The Impact

Background A recent document by the American Congress of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine introduced the concept of uniform levels of maternal care (LMCs). Objective We assessed LMC across hospitals and measured their association with maternal morbidity, focusing on women with high-risk conditions. Study Design We collected data from hospitals from May to November 2015 and linked survey responses to Statewide Inpatient Databases (SID) hospital discharge data in a retrospective cross-sectional study of 247,383 births admitted to 236 hospitals. Generalized logistic regression models were used to examine the associations between hospitals' LMC and the risk of severe maternal morbidity. Stratified analyses were conducted among women with high-risk conditions. Results High-risk pregnancies were more likely to be managed in hospitals with higher LMC (p < 0.001). Women with cardiac conditions had lower odds of maternal morbidity when delivered in level I compared with level IV units (adjusted odds ratio: 0.29; 95% confidence interval: 0.08–0.99; p = 0.049). There were no other significant associations between the LMC and severe maternal morbidity. Conclusion A higher proportion of high-risk pregnancies were managed within level IV units, although there was no overall evidence that these births had superior outcomes. Further prospective evaluation of LMC designation with patient outcomes is necessary to determine the impact of regionalization on maternal outcomes.

Download Full-text

Demographic and social correlates and indicators for behavioural compliance with personal protection among Chinese community-dwellers during COVID-19: a cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2020-041453 ◽

2021 ◽

Vol 11 (1) ◽

pp. e041453

Author(s):

Xin Xu ◽

Kimberly Ann Chew ◽

Xiaolin Xu ◽

Zhihua Wu ◽

Xiaohua Xiao ◽

...

Keyword(s):

Middle Age ◽

Social Indicators ◽

Age Groups ◽

Cross Sectional Study ◽

Inverse Association ◽

Personal Protection ◽

Cross Sectional ◽

Protective Measures ◽

Logistic Regression Models ◽

Community Dwellers

ObjectivesExamine compliance with personal protective measures in communities for the prevention and control of local transmission of the COVID-19, and explore indicators for such behavioural compliance.DesignCross-sectional design with a self-selecting sample. Data collected in February 2020.SettingCommunity dwellers in China.Participants2956 participants aged 16 and above completed the study and were included in the analysis.Outcome measuresNationwide COVID-19 survey. Demographics and self-reported compliance with four personal protective measures—home quarantine, mask-wearing, temperature-taking and hand-sanitising were collected. Outbreak severity and timeliness of personal protection order were obtained from the China Center for Disease Control and Prevention website. Logistic regression models were employed to examine the association between demographic and social indicators and behavioural compliance.ResultsCompliance with home quarantine was only associated with gender (men, OR=0.61 (0.51–0.73), inverse association) but no other indicators. In contrast, men had higher compliance with mask-wearing (OR=1.79 (1.49–2.16)) and temperature-taking (OR=1.27 (1.05–1.53)). Compared with younger adults (≤20 years), the middle-age groups (31–40 and 41–50 years of age) were more compliant with all protective behaviours, except for home quarantine (OR=0.71 (0.54–0.93) and 0.67 (0.46–0.97), respectively).ConclusionMale gender was associated with lower compliance with home quarantine yet higher compliance with mask-wearing and temperature-taking. The middle-age participants (31–50 years) had lower compliance with home quarantine but higher with other measures. These findings may be supported by the economic considerations and the long-inherited Confucian values among Chinese. In light of the ongoing COVID-19 pandemic, public health authorities should tailor policy implementation to disparities in psychosocial indicators.

Download Full-text

Examining the Dietary Diversity of Children in Niger

Nutrients ◽

10.3390/nu13092961 ◽

2021 ◽

Vol 13 (9) ◽

pp. 2961

Author(s):

Nafissatou Cisse Egbuonye ◽

Ariun Ishdorj ◽

E.L.J. McKyer ◽

Rahma Mkuu

Keyword(s):

Rural Areas ◽

Urban Areas ◽

Dietary Diversity ◽

Descriptive Analysis ◽

Age Groups ◽

Wealth Index ◽

Cross Sectional Study ◽

Health Concern ◽

Cross Sectional ◽

Child Factors

Malnutrition is a major public health concern in Niger. The stunting rate in children in Niger is over 50%, one of the highest in the world. The purpose of this cross-sectional study was to examine children’s dietary diversity (CDD) and the maternal factors that impact CDD. A total of 1265 mother–child pairs were analyzed. Descriptive analysis was conducted to present maternal and child characteristics. To compare the mean scores of CDD in relation to the region, an independent sample t-test was conducted. A one-way ANOVA test was conducted to evaluate the CDD score by different age groups. A linear regression model was estimated to identify household, maternal and child factors that affect the CDD score. Our results indicate that most of the participants of our survey resided in rural areas and the majority (80.7%) of the mothers had no education. Factors such as region, children’s age, woman’s empowerment, vitamin A intake and wealth index were significant predictors of CDD (p < 0.05). The children residing in rural areas were more likely to have lower CDD scores (p < 0.05) than the children in urban areas, therefore becoming more susceptible to malnutrition.

Download Full-text

Spontaneous Reporting of Adverse Drug Reaction Among Health Professionals In Kpone-Katamanso District, Ghana

10.21203/rs.3.rs-433485/v1 ◽

2021 ◽

Author(s):

Morrison Asiamah ◽

Kwadwo Owusu Akuffo ◽

Pricillia Nortey ◽

Nina Donkor ◽

Anthony Danso-Appiah

Keyword(s):

Health Professionals ◽

Spontaneous Reporting ◽

Effective Means ◽

Cross Sectional Study ◽

Health Concern ◽

Pharmacovigilance System ◽

Cross Sectional ◽

Logistic Regression Models ◽

Adequate Knowledge ◽

Statistical Adjustment

Abstract Background: Spontaneous reporting of adverse drug reactions (ADR) is an effective means of ensuring postmarketing surveillance of drugs, and health professionals play a cardinal role through voluntary reporting of ADR. However, the pharmacovigilance system in Ghana is plagued with under-reporting issues, which is of public health concern. Method: A questionnaire-based cross-sectional study involving 268 health professionals at Kpone-Katamanso District was carried out. Data on spontaneous reporting of ADR, demographics of participants, knowledge, and attitudes of professionals towards reporting and factors that may influence ADR reporting were collected. Logistic regression models were used to examine the association of the independent variables with spontaneous reporting of ADR.Result: Overall, 77.6% (208) of the 268 respondents had witnessed ADR; however, only 17.3% of the respondents have ever reported an ADR to the FDA. Health professionals who had adequate knowledge on spontaneous reporting of ADR were 51.9%, while 30.3% had very good knowledge of spontaneous reporting of ADR. After statistical adjustment, Age (AOR=2.26, 95%CI= 1.25–4.10), Fear of Legal Consequences (AOR=0.15, 95%CI=0.41–0.51), Time Constraint (AOR=0.3, 95%CI=0.10–0.91), Pharmacovigilance training (AOR= 18.78, 95%CI= 5.46–64.59) and Unavailability of Reporting form (AOR=0.28, 95%CI=0.09– 0.88) were found to be significantly associated spontaneous reporting of ADR. Conclusion: The proportion of health professionals in the Kpone-Katamanso District who spontaneously report observed ADR is low. Our findings underscore the need for the FDA to intensify awareness through media sensitization and engage all relevant stakeholders on the need for the entire population to report ADR.

Download Full-text

The Global Impact of COVID-19 on Craniomaxillofacial Surgeons

Craniomaxillofacial Trauma & Reconstruction ◽

10.1177/1943387520929809 ◽

2020 ◽

Vol 13 (3) ◽

pp. 157-167 ◽

Cited By ~ 2

Author(s):

Justin van der Tas ◽

Thomas Dodson ◽

Daniel Buchbinder ◽

Stefano Fusetti ◽

Michael Grant ◽

...

Keyword(s):

Virus Disease ◽

Statistical Significance ◽

Binary Logistic Regression ◽

Cross Sectional Study ◽

Geographic Region ◽

Outcome Variable ◽

Cross Sectional ◽

Logistic Regression Models ◽

Long Term Impact ◽

The Impact

Study Design: The COrona VIrus Disease-19 (COVID-19) pandemic has disrupted craniomaxillofacial (CMF) surgeons practice worldwide. We implemented a cross-sectional study and enrolled a sample of CMF surgeons who completed a survey. Objective: To measure the impact that COVID-19 has had on CMF surgeons by (1) identifying variations that may exist by geographic region and specialty and (2) measuring access to adequate personal protective equipment (PPE) and identify factors associated with limited access to adequate PPE. Methods: Primary outcome variable was availability of adequate PPE for health-care workers (HCWs) in the front line and surgeons. Descriptive and analytic statistics were computed. Level of statistical significance was set at P < .05. Binary logistic regression models were created to identify variables associated with PPE status (adequate or inadequate). Results: Most of the respondents felt that hospitals did not provide adequate PPE to the HCWs (57.3%) with significant regional differences ( P = .04). Most adequate PPE was available to surgeons in North America with the least offered in Africa. Differences in PPE adequacy per region ( P < .001) and per country ( P < .001) were significant. In Africa and South America, regions reporting previous virus outbreaks, the differences in access to adequate PPE evaporated compared to Europe ( P = .18 and P = .15, respectively). Conclusion: The impact of COVID-19 among CMF surgeons is global and adversely affects both clinical practice and personal lives of CMF surgeons. Future surveys should capture what the mid- and long-term impact of the COVID-19 crisis will look like.

Download Full-text

B Part of It School Leaver protocol: an observational repeat cross-sectional study to assess the impact of a meningococcal serogroup B (4CMenB) vaccine programme on carriage ofNeisseria meningitidis

BMJ Open ◽

10.1136/bmjopen-2018-027233 ◽

2019 ◽

Vol 9 (5) ◽

pp. e027233 ◽

Cited By ~ 3

Author(s):

Helen S Marshall ◽

Mark McMillan ◽

Ann Koehler ◽

Andrew Lawrence ◽

Jenny MacLennan ◽

...

Keyword(s):

Controlled Trial ◽

Age Groups ◽

Case Fatality ◽

Cluster Randomised Controlled Trial ◽

Cross Sectional Study ◽

Sectional Study ◽

School Students ◽

Cross Sectional ◽

The Impact ◽

Carriage Prevalence

IntroductionInvasive meningococcal disease is uncommon but associated with a high-case fatality rate. Carriage prevalence of the causative bacteria,Neisseria meningitidis, is high in adolescents. A large (n=34 500) cluster randomised controlled trial (RCT) to assess the impact of a meningococcal B (MenB) vaccine on meningococcal carriage was implemented in the state of South Australia (SA) for year 10, 11 and 12 senior school students in 2017–2018. This study will assess the impact of MenB vaccine (4CMenB) on carriage prevalence in school leavers in SA, 1 and 2 years after implementation of the cluster RCT in adolescents. Measuring the impact of population programmes on carriage can assist in informing future meningococcal immunisation programmes such as targeted age groups and use of catch-up campaigns.Methods and analysisThis repeat cross-sectional study will assess carriage prevalence in 2018 and 2019. All school leavers who attended year 12 in any school in SA in 2018 or 2019 will be invited to participate in this study. An oropharyngeal swab will be taken from each participating student and a risk factor questionnaire completed by the student following informed consent. Students will attend clinics at SA universities, technical colleges, and metropolitan, rural and remote government council clinics. Confirmed vaccination history will allow a comparison in carriage prevalence between vaccinated and unvaccinated school leavers. A sample size of 4096 students per year will provide 80% power to detect a 20% difference in carriage prevalence of disease-causing meningococci (defined as genogroup A, B, C, W, X or Y) between years.Ethics and disseminationThe study was approved by the Women’s and Children’s Health Network Human Research Ethics Committee. Results will be published in international peer review journals and presented at national and international conferences.Trial registration numberNCT03419533; Pre-results

Download Full-text

Sex Differences in the Association Between Food Insecurity and Obesity Among College Students

Current Developments in Nutrition ◽

10.1093/cdn/nzaa043_032 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 181-181

Author(s):

Aseel El Zein ◽

Karla Shelnutt ◽

Sarah Colby ◽

Geoffrey Greene ◽

Wenjun Zhou ◽

...

Keyword(s):

College Students ◽

Logistic Regression ◽

Food Security ◽

Food Insecurity ◽

Cross Sectional Study ◽

High Food ◽

Cross Sectional ◽

Logistic Regression Models ◽

Food And Agriculture ◽

Increased Risk

Abstract Objectives This study aimed to assess the association between food insecurity and obesity and to examine whether it varies by sex. Methods A cross-sectional study was conducted in spring 2017 among college students from eight U.S. institutions. Participants (n = 683) completed the USDA Adult Food Security Survey and had their weight and height measured by researchers. Multivariate logistic regression models were used to estimate the sex-specific associations between food insecurity and obesity (BMI ≥ 30 kg/m2), after adjusting for socioeconomic covariates. Results Overall, 25.4% of students identified as food insecure and 10.5% were obese. The prevalence of obesity increased as the level of food insecurity increased, from 5.2% for those with high food security, 13.4% for those with marginal food security, to 17.4% and 21.6% for students with low and very low food security. In logistic regression analysis, marginal, low and very low food security students had an odds ratio of 2.83 (95% CI: 1.43, 5.57), 3.86 (95% CI: 1.88, 7.91), and 5.05 (95% CI:, 2.44, 10.48) of obesity compared to students with high food security, exhibiting a dose-response relationship. Among females, having marginal (OR = 4.21, 95% CI: 1.70, 9.75), low (OR = 4.51, 95% CI: 1.40, 12.47), or very low food security (OR = 7.08, 95% CI: 2.60, 18.41) predicted higher odds of obesity compared to female students with high food security. Among males, those with low food security had higher odds of obesity (OR = 6.40, 95% CI: 1.78, 20.7). Conclusions The association between food insecurity and obesity in U.S. college students remained after adjustment for multiple socio-economic factors. Overall, food insecure females experienced an increase in the risk of obesity as food insecurity increased; however, only males with low food security had an increased risk of obesity. Programs directed toward obesity prevention need to address any level of food insecurity as a risk factor in females, and target males with low food security. Although beyond the scope of this study, it is possible that programs to reduce food insecurity may help prevent obesity in college students. Funding Sources This material is based upon work that is supported by the National Institute of Food and Agriculture, U.S. Department of Agriculture, under award number 2014–67,001-21,851.

Download Full-text

Is there an association between ageist attitudes and frailty?

BMC Geriatrics ◽

10.1186/s12877-019-1357-y ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Douglas Salguero ◽

Juliana Ferri-Guerra ◽

Nadeem Y. Mohammed ◽

Dhanya Baskaran ◽

Raquel Aparicio-Ugarriza ◽

...

Keyword(s):

Older Adults ◽

Logistic Regression ◽

Multinomial Logistic Regression ◽

Frailty Index ◽

Cross Sectional Study ◽

Community Dwelling ◽

Outcome Variable ◽

Cross Sectional ◽

Logistic Regression Models ◽

Frailty Status

Abstract Background Frailty is defined as a state of vulnerability to stressors that is associated with higher morbidity, mortality and healthcare utilization in older adults. Ageism is “a process of systematic stereotyping and discrimination against people because they are old.” Explicit biases involve deliberate or conscious controls, while implicit bias involve unconscious processes. Multiple studies show that self-directed ageism is a risk factor for increased morbidity and mortality. The purpose of this study was to determine whether explicit ageist attitudes are associated with frailty in Veterans. Methods This is a cross-sectional study of Veterans 50 years and older who completed the Kogan’s Attitudes towards Older People Scale (KAOP) scale to assess explicit ageist attitudes and the Implicit Association Test (IAT) to evaluate implicit ageist attitudes from July 2014 through April 2015. We constructed a frailty index (FI) of 44 variables (demographics, comorbidities, number of medications, laboratory tests, and activities of daily living) that was retrospectively applied to the time of completion of the KAOP and IAT. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by multinomial logistic regression models with frailty status (robust, prefrail and frail) as the outcome variable, and with KAOP and IAT scores as the independent variables. Age, race, ethnicity, median household income and comorbidities were considered as covariates. Results Patients were 89.76% male, 48.03% White, 87.93% non-Hispanic and the mean age was 60.51 (SD = 7.16) years. The proportion of robust, pre-frail and frail patients was 11.02% (n = 42), 59.58% (n = 227) and 29.40% (n = 112) respectively. The KAOP was completed by 381 and the IAT by 339 participants. In multinomial logistic regression, neither explicit ageist attitudes (KAOP scale score) nor implicit ageist attitudes (IAT) were associated with frailty in community dwelling Veterans after adjusting for covariates: OR = .98 (95% CI = .95–1.01), p = .221, and OR:=.97 (95% CI = .37–2.53), p = .950 respectively. Conclusions This study shows that neither explicit nor implicit ageist attitudes were associated with frailty in community dwelling Veterans. Further longitudinal and larger studies with more diverse samples and measured with other ageism scales should evaluate the independent contribution of ageist attitudes to frailty in older adults.

Download Full-text